Spatial analysis of HIV detection rates among Brazilian young men, 2007-2021.

The main goal of this study was to spatially analyze the HIV epidemic scenario in young men in Brazil, 2007-2021. We used secondary data obtained from the Brazilian Information System for Notifiable Diseases. Individuals aged 15-29 years with permanent residence in Brazil who were diagnosed with HIV during the study period were included in the analysis. Municipality HIV age-adjusted detection rates were analyzed through spatial distribution, autocorrelation, and spatiotemporal risk analyses. During the study period, 108,392 HIV cases were reported in young Brazilian men. The HIV epidemic increased territorially in the northern, northeastern, midwestern, and southeastern regions but decreased in the southern region. Although the number of clusters comprising municipalities with high HIV detection rates (hotspots) decreased, new ones appeared, expanded, or stopped changing size. Hotspots and spatio-temporal risk zones (spatial areas with increased HIV detection in a specific period) comprised economically developed municipalities with high demographic density surrounded by less developed municipalities. The period of the spatiotemporal risk zones was between 2008 and 2021. Our study showed that HIV detection rates continue to increase among young Brazilian men, and health authorities should reinforce efforts mainly in capitals and surrounded municipalities in the north, northeast, southeast, and midwest regions.

Social and individual vulnerability factors associated with syphilis among populations living on islands in the Brazilian Amazon.

BACKGROUND: The repercussions of the syphilis epidemic differ according to populations. Identifying and acknowledging the differences and specificities of populations is fundamental in the design and implementation of policies aimed at assisting the groups most vulnerable to syphilis. OBJECTIVE: To estimate the prevalence of antibodies against Treponema pallidum and associated vulnerability factors among riverside populations of a capital city in the Brazilian Amazon. METHODS: Cross-sectional study was conducted among residents of the periurban islands in Belém, northern Brazil, from August 2020 to January 2021. The inclusion criterion was being a resident of the riverside communities of the Combú Environmental Protection Area, aged 18 years or over. The participants responded to questionnaire and were tested for syphilis using rapid test. Data were analyzed using multiple logistic regression by Minitab version 20® software. RESULTS: Overall, a total of 325 riverine were included. Age varied from 18 to 91 years (average 40 years). Prevalence of markers for syphilis was 5.9% (95% CI: 3.3%-8.4%). The multiple regression showed that as age increases, the chances of having syphilis also increase (p = 0.001; aOR: 1.04) and riverside dwellers with more than one sexual partner in the last 6 months had more than four chances of having syphilis compared to people who had only one sexual partner (p = 0.007; aOR: 4.20). CONCLUSION: Syphilis circulates among traditional populations in the Amazon and is associated with factors of social and individual vulnerability.

Human immunodeficiency virus epidemic scenery among brazilian women: a spatial analysis study.

BACKGROUND: Approximately 37.7 million people worldwide are infected with human immunodeficiency virus (HIV). Although HIV detection among women, they still representing 53% of population living with the virus. Spatial analysis techniques are powerful tools for combating HIV allowing the association of the phenomenon with socioeconomic and political factors. Therefore, the main goal of this study was to spatially analyze HIV prevalence among Brazilian women from 2007 to 2020. METHODS: ecological study was conducted using secondary databases of the Notifiable Diseases Information System (SINAN) for HIV and Acquired Immunodeficiency Syndrom (AIDS) in Brazilian women 15 years old and over. Age-adjusted HIV/AIDS incidence rates were analyzed using spatial distribution, autocorrelation, and spatiotemporal risk analysis techniques. RESULTS: During the study period, 119,890 cases of HIV/AIDS were reported among Brazilian women. The southeastern region had a higher age-adjusted HIV/AIDS incidence than other Brazilian regions. Hotspot HIV/AIDS incidence rates decreased in all Brazil. Piauí, Paraná, and Minas Gerais were the only states with an increased number of cold spots. Previous spatiotemporal risk zones were observed in the states of São Paulo, Rio Grande do Sul, and Rio de Janeiro. Belém was a risk zone with a later spatiotemporal risk. CONCLUSIONS: The efficiency of public policies fighting HIV has not been uniform among municipalities, although HIV/AIDS cases have decreased among Brazilian women. The social determinants of health in each municipality should be considered when local health authorities implement policies. Women empowerment should be promoted, and access to preventive, diagnostic, and treatment healthcare places should be expanded and guaranteed.

Hospitalizations for congenital syphilis in children under one year old in the state of Pará, Brazilian Amazon: ecological study.

BACKGROUND: The high incidence of congenital syphilis shows flaws in the resolution of primary health care, being a predictor of greater use of hospital services, whose regional differences in access to health actions and services may be reflected in health inequalities. OBJECTIVE: to investigate hospitalizations due to congenital syphilis in children under one year of age, in the state of Pará, Brazilian Amazon. METHODS: an ecological study was carried out, using hospitalization, lethality and mortality rates related to congenital syphilis in children under one year of age. Temporal analysis and mapping of hospitalization flows were carried out using Joinpoint®, version 4.7.0.0, Terraview 4.2.2, Tabwin 4.1.5. RESULTS: A total of 6,487 hospitalizations were recorded. For the ten years of the study period (2009 to 2018), the lethality rate showed a decreasing trend of - 13.5% (p = 0.01). The crude hospitalization rate showed an increasing trend of 12.8% (p < 0.000. The regression analysis demonstrated that there was a change point in the trend with a significant growth of 12.8% until 2016 (p = 0.0006). In the mortality rate the trend was stable (p = 0.56). The analysis of hospitalization care flows made it possible to identify that most hospitalizations due to congenital syphilis occurred in the municipalities of residence, but 1,378 (21.2%) had to move. Two large care gaps were highlighted in Metropolitan health regions II and III, belonging to macroregion II. The hospitalizations of residents of these regions were carried out by the assistance networks of Belém (capital) and Marituba, both of which are part of Metropolitana I. Residents of macroregions III and IV had the greatest distances traveled to access hospital care. CONCLUSIONS: The increase in the rate of hospitalizations with an increasing trend demonstrates the impact that syphilis still causes in Brazil, not being resolved even after national government interventions in primary health care, but there was a decreasing trend in the fatality rate. The results demonstrate a heterogeneous organization of health care networks in the state's health regions and macroregions.

Leprosy and tuberculosis control scenario of the national program for the improvement of access and quality of primary care in Brazil.

BACKGROUND: In Brazil, despite advances in public health policies aimed at eliminating and controlling infectious and parasitic diseases, the incidence of neglected diseases is still high. The epidemiological scenario in Brazil of diseases such as tuberculosis and leprosy evidences a public policy agenda that has not been resolute in terms of control, nor in terms of elimination. OBJECTIVE: To analyze the actions of diagnosis and treatment of leprosy and tuberculosis in the context of primary health care. METHODS: In this ecological study, data from the third cycle of the Program for the Improvement of Access and Quality of Primary Care were extracted from electronic address of the Primary Health Care Secretariat of Brazil in the area of Actions, Programs and Strategies. A total of 37,350 primary health care teams were that answered the questionnaire were eligible, with variables extracted from leprosy and tuberculosis control actions. The municipalities were grouped according to the characteristic of the Brazilian municipality. The partition chi-square and the Residuals Test were used to assess whether there was a difference in the proportion of tuberculosis and leprosy actions between types of municipalities. Statistics were carried out using Minitab 20 and Bioestat 5.3. RESULTS: Regarding the leprosy treatment location, there is a higher proportion of people referred to be treated at the reference in adjacent rural (p = 0.0097) and urban (p < 0.0001) municipalities; monitoring of people with leprosy referred to the service network (p. = 0.0057) in remote rural areas. Lower proportion of teams requesting bacilloscopy in remote rural areas (p = 0.0019). Rural areas have a higher proportion of teams that diagnose new cases (p = 0.0004). Regarding the actions of diagnosis and treatment of tuberculosis. There is a higher proportion of teams that carry out consultations at the unit itself in rural areas when compared to adjacent intermediaries (p = 0.0099) and urban (p < 0.0001); who requested sputum smear microscopy in adjacent intermediaries (p = 0.0021); X-ray in adjacent intermediaries (p < 0.0001) and urban (p < 0.0001); collection of the first sputum sample in urban (p < 0.0001) and adjacent rural areas (p < 0.0001); directly observed treatment (p < 0.0001) in adjacent rural municipalities. CONCLUSION: There are inequalities in the diagnosis and treatment of leprosy and tuberculosis among the types of municipalities.

LEARNHIV: development and validation of a mobile application for primary health care nurses focused on HIV care/prevention.

INTRODUCTION: Human immunodeficiency virus (HIV) infection is a relevant public health problem is worldwide. From the change in the health care of people living with HIV (PLHIV) in Primary Health Care (PHC), nurses gained autonomy in their workflow, which requires a significant technological arsenal for the planning, organization and functioning of services. It is believed that the development of a mobile application for the care/prevention of HIV will contribute to the strengthening of care, resulting in greater autonomy and empowerment of nurses in Primary Health Care. OBJECTIVE: To develop and validate a content script for a mobile application for nurses in PHC containing information about PLHIV management/care in PHC. METHODS: This is a methodological study developed in three phases: exploratory study, content elaboration process and validation by the 16 judges. RESULTS: The application was evaluated and validated satisfactorily in terms of content and appearance, with an average Content Validity Index (CVI) of 0.99 (99%), Item Content Validity Index (I-CVI) and Medium Content Validity (S-IVC/AVE) also obtained satisfactory levels. CONCLUSIONS: The construction of the prototype of an application called LearnHIV, is considered a valid instrument in terms of content and appearance, according to the judges. TRIAL REGISTRATION: None because it is not an intervention study.

Temporal trend and spatial analysis of the HIV epidemic in young men who have sex with men in the second largest Brazilian Amazonian province.

BACKGROUND: After 40 years of its starting, the HIV epidemic in Brazilian Amazon region remains on an increasing trend. The young men who have sex with men (MSM) have been the most impacted by the HIV in the last decade. However, much more than attributing the risk behavior to HIV uniquely to the individual, behaviors are shaped by social determinants of health (SDH). Despite the problem, there is a scarcity of studies evaluating the impact of SDH on HIV among young MSM and none of them were done in the Northern of Brazil. Therefore, the main goal of this study was to analyse the HIV epidemic among Brazilian Amazonian young MSM using temporal trends and spatial analysis. METHODS: We conducted an ecological study using reported cases of HIV/AIDS in young MSM living in Pará, the second larger Brazilian Amazonian province, between 2007 and 2018. Data were obtained from the Information System for Notifiable Diseases. For the temporal analysis, we employed a Seasonal and Trend decomposition using Loess Forecasting model (STLF), which is a hybrid time-series forecast model, that combines the Autoregressive-Integrated Moving Average (ARIMA) forecasting model with the Seasonal-Trend by Loess (STL) decomposition method. For the spatial analysis, Moran's spatial autocorrelation, spatial scan, and spatial regression techniques were used. RESULTS: A total of 2192 notifications were included in the study. Greater variabilities in HIV/AIDS population-level diagnosis rates were found in the festive months. The HIV/AIDS population-level diagnosis rates exhibited an upward trend from 2013 and this trend is forecasted to continue until 2022. Belém, the capital of Pará, presented the highest spatial risk for HIV/AIDS and was the only city to present spatiotemporal risk from 2014 to 2018. The geographic variation of the HIV epidemic was associated with the number of men with formal jobs, the average salary of men, and the percentage of people over 18 years old with elementary education. CONCLUSION: The upward trend of HIV/AIDS population-level diagnosis rate forecasted until 2022 and the variability of the epidemic promoted by the SDH brings an alert and subsidies to health authorities to implement more efficient and focalized public policies against HIV among young MSM in Pará.

The HIV epidemic in Colombia: spatial and temporal trends analysis.

BACKGROUND: Colombia has the fourth highest incidence rate of HIV/AIDS among all Latin American countries and it has been increasing since the 1980s. However, the number of studies that addresses this trend is limited. Here, we employed spatial and temporal trend analyses to study the behaviour of the epidemic in the Colombian territory. METHODS: Our sample included 72,994 cases of HIV/AIDS and 21,898 AIDS-related deaths reported to the National Ministry of Health between 2008 and 2016. We employed the joinpoint regression model to analyse the annual HIV/AIDS incidence and AIDS mortality rates. In the spatial analysis, we used univariate autocorrelation techniques and the Kernel density estimator. RESULTS: While the HIV/AIDS incidence had an increasing trend in Colombia, the AIDS mortality rate was stable. HIV/AIDS incidence and AIDS mortality showed a downward trend in the 0-14 age group. An upward trend was observed for HIV/AIDS incidence in people older than 15 years and with the highest trend in the 65 years and above group. AIDS mortality showed an increasing trend among people aged 65 years or older. The comparison between the sexes showed an upward trend of HIV/AIDS incidence in all age groups and AIDS-mortality rates in 65 years and above in men, while in women, the incidence was upward among those aged 45 years and above, and concerning the AIDS-mortality rate in the 45-64 group. The high-high clusters of HIV/AIDS incidence and AIDS mortality were located in the Andean and Caribbean regions. CONCLUSION: Our study found an upward trend in HIV/AIDS incidence and a stable trend in the AIDS mortality rate in Colombia. The downward trend in HIV/AIDS incidence and AIDS mortality rate in the 0-14 age group reflects the downwards mother-to-child HIV transmission. The upward trend in HIV/AIDS incidence in older women and AIDS mortality in younger women rates, compared with men, may be due to late diagnosis and treatment. The Caribbean and the 'coffee belt' regions were the most impacted by the HIV epidemic, most likely due to sexual tourism. Our results provide crucial information that may help Colombian health authorities fight HIV transmission.

Polygala sabulosa A.W. Bennett extract mitigates motor and cognitive deficits in a mouse model of acute ischemia.

Stroke is considered one of the leading causes of death worldwide. The treatment is limited; however, the Brazilian flora has a great source of natural products with therapeutic potentials. Studies with the medicinal plant Polygala sabulosa W. Bennett provided evidence for its use as an anti-inflammatory and neuroprotective drug. In the case of ischemic stroke due to lack of oxygen, both acute and chronic inflammatory processes are activated. Thus, we hypothesized that P. sabulosa (HEPs) has the potential to treat the motor and cognitive deficits generated by ischemic stroke. Male mice were subjected to global ischemia for 60 min, followed by reperfusion and orally treated with HEPs (100 mg/kg in saline + 3% tween 20) twice a day (12 h apart) for 48 h starting 3 h after surgery. Motor skills were assessed using grip force and open field tasks. Hippocampi were then collected for mRNA quantification of the cytokines IL-1-ß and TNF-α levels. After 48 h of acute treatment, spatial reference memory was evaluated in a Morris water maze test for another group of animals. We show that HEPs treatment significantly prevented motor weakness induced by ischemia. Brain infarct area was reduced by 22.25% with downregulation of the levels of IL-1ß and TNF-α mRNA. Learning performance and memory ability on Morris water maze task were similar to the sham group. Our data demonstrates the neuroprotective properties of HEPs through its anti-inflammatory activities, which prevent motor and cognitive impairments, suggesting that HEPs may be an effective therapy for ischemic stroke.

Human T-lymphotropic virus 1aA circulation and risk factors for sexually transmitted infections in an Amazon geographic area with lowest human development index (Marajó Island, Northern Brazil).

BACKGROUND: This cross-sectional study evaluated the prevalence of infection with human T-lymphotropic virus 1 and 2 (HTLV-1 and HTLV-2) in a population from the municipalities of Anajás, Chaves, São Sebastião da Boa Vista (SSBV) and Portel in the Marajó Archipelago and correlated these data with the epidemiological characteristics of the study population. METHODS: A total of 1899 biological samples were evaluated. The samples were screened for the presence of anti-HTLV antibodies using an enzyme-linked immunosorbent assay (ELISA), and infection was confirmed using conventional polymerase chain reaction (PCR), real-time PCR and nucleotide sequencing. RESULTS: Eleven samples (0.58%) were seropositive for HTLV, but molecular analysis confirmed positivity in only two samples (0.11%). Nucleotide sequencing and phylogenetic analysis indicated that the two samples positive for HTLV-1 that were isolated in Chaves belonged to the Cosmopolitan subtype 1 (HTLV-1a) and Transcontinental subgroup (A). CONCLUSION: Our results confirmed the presence of Cosmopolitan Transcontinental HTLV-1 in the Marajó Archipelago, Amazon region, and the majority of the population revealed a lack of knowledge about sexually transmitted infections, which increases the risk of dissemination of HTLV and other agents.

Prevalence and risk behaviour for human immunodeficiency virus 1 infection in Marajó Island, Northern Brazil.

BACKGROUND: Human immunodeficiency virus 1 (HIV-1) infection is a global public health problem, but, so far, there is no published information regarding the epidemiology of HIV-1 in Marajó Archipelago (Pará, Brazil). AIM: The present study reports the occurrence of infection by HIV-1 in four municipalities of the Marajó Island, Pará, Brazil. SUBJECTS AND METHODS: A total of 1877 samples were collected from volunteer blood donors (1296 women and 551 men) living in the municipalities of Anajás, Chaves, Portel and São Sebastião da Boa Vista. Information about risk behaviour assessment was obtained from a questionnaire. Plasma samples were tested for the presence of anti-HIV antibodies using serological tests. The infection was confirmed by nucleic acid amplification assays. RESULTS: Twelve samples were seropositive for HIV by ELISA. Western blot analysis showed four positive samples, eight indeterminate patterns and one found to be negative. Molecular analysis revealed three positive samples. Risk factors for HIV-1 infection included absence of condoms during sexual intercourse (41.3%, São Sebastião da Boa Vista), use of illicit drugs (5.8%, Anajás) and early initiation of sexual activities, from 10-15 years (30.7%). CONCLUSION: Although the study indicates a low HIV-1 prevalence in Marajó Island, some factors may increase the risk for HIV-1 and these include early sexual initiation, unprotected sexual intercourse and the use of illicit drugs.

Demographic Profile, Health, and Associated Factors of Family Caregivers and Functionality of Hospitalized Older Adults: Cross-Sectional, Exploratory, and Descriptive Study.

BACKGROUND: The longevity of the world population can contribute to an increase in hospitalizations and, consequently, to the emergence of functional limitations, resulting in the need for family caregivers. Hospitalized older adults may become dependent and require more care, increasing the burden on family caregivers. Thus, the nursing team in the hospital environment faces a new situation: an increase in the number of older adults occupying hospital beds and the presence of their family caregivers. OBJECTIVE: We aimed to analyze the association between the demographic variables of interest and the self-rated health of family caregivers and to describe the functionality of older adults hospitalized in a university hospital in the Amazonian context. METHODS: This cross-sectional, quantitative, exploratory, and descriptive study was carried out through individual interviews with 98 interviewees, divided into 49 family caregivers and 49 older adults hospitalized in the surgical clinic sector of a university hospital in Brazil between February and March 2023. Demographic data and health conditions were collected from family caregivers, and to describe the functionality of hospitalized older adults, the Barthel Index was applied. Descriptive (frequency and percentage) and inferential analyses were used, and the student t test was applied. The significance level of 5% was adopted. RESULTS: Among the 49 family caregivers, the majority were women (n=40, 81.6%) with an average age of 46.9 (SD 13.3) years. Most were single (n=28, 57.1%) and had completed an average level of education (n=26, 53.1%). Additionally, 25 (51%) caregivers were caring for their parents. Regarding health conditions, respondents self-assessed their health as good (25/49, 51%; P=.01), and they considered that their health status was not affected by the provision of care (36/49, 73.5%; P=.01). There was a significant association between demographic variables (ie, gender, age, and education) and self-assessment of family caregivers (P=.01, P=.01, and P=.04, respectively). Of the 49 older adults hospitalized, the majority (n=31, 63.2%) were men, with a mean age of 69.2 (SD 7.12) years. Regarding the assessment of functionality, most older adults were classified as having mild dependence on care (n=23, 46.9%), specifically in the age group between 60 and 69 years (21/49, 67.8%). CONCLUSIONS: The data revealed that female gender, age, and education of family caregivers contributed favorably to the provision of care to hospitalized older adults with a lower degree of functional dependence. It is important to emphasize that during the older adult's hospitalization, the family caregiver should not be seen as a delegation of responsibilities or as a complement of human resources to assist in their recovery. Health professionals need to implement assertive interventions so that the family caregiver functions as a therapeutic resource.

Demographic, social, and clinical aspects associated with access to COVID-19 health care in Pará province, Brazilian Amazon.

Internal social disparities in the Brazilian Amazon became more evident during the COVID-19 pandemic. The aim of this work was to examine the demographic, social and clinical factors associated with access to COVID-19 health care in Pará Province in the Brazilian Amazon. This was an observational, cross-sectional, analytical study using a quantitative method through an online survey conducted from May to August 2023. People were eligible to participate if they were current residents of Pará, 18-years-old or older, with self-reported diagnoses of COVID-19 through rapid or laboratory tests. Participants completed an electronic survey was developed using Research Electronic Data Capture (REDCap) software-The adapted questionnaire "COVID-19 Global Clinical Platform: Case Report Form for Post-COVID Condition". Questions focused on access to COVID-19 treatment, demographic characteristics, COVID-19 vaccine and clinical characteristics. Respondent-driven sampling was applied to recruit participants. Multiple logistic regression was utilized to identify the associated factors. Overall, a total of 638 participants were included. The average age was 31.1 years. Access to COVID-19 health care was 68.65% (438/638). The participants most likely to access health care were those with moderate or severe COVID-19 (p = 0.000; OR: 19.8) and females (p = 0.001; OR: 1.99). Moreover, participants who used homemade tea or herbal medicines were less likely to receive health care for COVID-19 in health services (p = 0.002; OR: 0.54). Ensuring access to healthcare is important in a pandemic scenario.

Amplified HIV Transmission Risk Among People Living With HIV in Southeast Brazil.

ABSTRACT: This study investigated the factors associated with amplified HIV transmission risk among people living with HIV from a city in southeast Brazil. A cross-sectional study was conducted with 397 people living with HIV recruited in infectious diseases clinics. Data on risk of HIV transmission, sociodemographic characteristics, sexual behaviors, professional counseling, serological HIV status, HIV-related clinical data, and beliefs about risk of HIV transmission were collected through interviews and medical records. Hierarchical ordered multinomial regression analyses were performed. Amplified HIV risk transmission was associated with lower age, alcohol consumption before having sex, illicit drug use before sexual intercourse, and not receiving professional counseling about HIV transmission. The belief that HIV can be transmitted to a partner not living with HIV was associated with lower likelihood of amplified risk for HIV transmission. Our findings suggest the importance of minimizing substance use before having sex, professional counseling, and beliefs about HIV transmission on amplified HIV risk transmission.

AIDS-related mortality in Pará Province, Brazilian Amazon region: Spatial and temporal analysis.

Despite considerable therapeutic advances in the care of people living with human immunodeficiency virus (HIV) and with the acquired immunodeficiency syndrome (AIDS) and an overall reduction of 47% in the AIDS mortality rate in the last decade, the AIDS-mortality rates remains high. The social determinants of health (SDH) have a direct influence on the dynamics of this phenomenon. However, changes in SDH caused by the implemented policies against HIV have been poorly investigated. Moreover, the Brazilian rainforest has had the highest and continuously increasing AIDS mortality rate in Brazil since the 1980s. In this study, AIDS mortality in a province of the Brazilian rainforest was examined by using temporal and spatial analyses. METHODS: In this ecological study, data from 2007 to 2018 were extracted from the Mortality Information System provided by the State Department of Public Health of Pará. For the temporal analysis, the integrated autoregressive model of moving average (ARIMA) and locally weighted polynomial regression (STLF) were used to forecast AIDS mortality from 2019 to 2022. For the spatial analysis, spatial autocorrelation and geographically weighted regression (GWR) analyses were employed. RESULTS: The samples consisted of 6,498 notifications for AIDS-related deaths. From 2007 to 2013, the AIDS mortality rates showed an upward trend, followed by a stabilization until 2018 and an upward forecasted trend from 2019 to 2022. High mortality rates and high-high clusters were found in economic pole municipalities. Furthermore, AIDS mortality risk was directly associated with per capita income and demographic density, except in the southwestern region of Pará, which exhibited an inverse association with population density. CONCLUSION: Although the policies against HIV may have contributed to the stabilization of AIDS mortality rates from 2013 in Pará, the upward forecasted trend until 2022 raises an alert and concern to health authorities to provide reinforcement of the policies. The geographic variability of AIDS mortality promoted by SDH provides subsidies to health authorities to implement SDH-focused strategies for AIDS mortality reduction.

Fall-Related Hospitalizations in Elderly People: Temporal Trend and Spatial Distribution in Brazil.

This study aims to identify the temporal variation and the spatial dependence structure of the hospitalization rate for falls in the elderly residing in Brazil in the period between 2010 and 2021. This ecological study employs secondary data from the Brazilian Ministry of Health about the fall-related hospitalization of people aged 60 years old and over. A time-series analysis was carried out, employing the joinpoint model. For the spatial analysis, the Moran autocorrelation technique was employed. In Brazil, between 2010 and 2021, there were 1,270,341 hospitalizations for falls recorded among the elderly in the Brazilian Hospitalization System. There was a continuous upward trend between 2010 and 2019 for all age groups, female and male, and all Brazilian regions. The trend stabilized between 2019 to 2021. The North and Northeast regions had faster upward trends among all Brazilian regions, and there was also a faster upward trend among women compared to men. A high-high pattern in hospitalization incidence was noticed from 2011 to 2019 in the states of São Paulo, Minhas Gerais, Paraná, and Mato Grosso do Sul. The results of this study provide subsidies for Brazilian health authorities to implement more efficient public policies to improve the quality of life of elderly people.

Demographic, Clinical, and Quality of Life Profiles of Older People With Diabetes During the COVID-19 Pandemic: Cross-Sectional Study.

BACKGROUND: Diabetes mellitus, one of the main diseases that affects the Brazilian population older than 60 years, is defined as a divergent group of metabolic disorders that present a high level of glycemia (hyperglycemia), causing damage to various organs and systems of the body, including the heart, kidneys, eyes, and nervous system. It is believed that in 2025, in Brazil alone, there will be more than 18.5 million individuals diagnosed with diabetes mellitus. Therefore, it is important to know the individuals' quality of life in the context of life and culture. OBJECTIVE: This study aimed to assess the demographic, clinical, and quality of life profiles of older adults with diabetes during the COVID-19 pandemic in a university hospital complex in the northern Amazon region. METHODS: We conducted a cross-sectional, exploratory, noninterventional, descriptive, and analytical study using a nonrandom sample of 54 older people diagnosed with diabetes mellitus at the geriatrics outpatient clinic of the medium and high complexity university hospital in the western Brazilian Amazon between 2020 and 2022. We used 3 instruments, namely, a sociodemographic questionnaire, a clinical conditions questionnaire, and Diabetes-39. Qualitative data were described using absolute and relative frequencies. The Kolmogorov-Smirnov normality test was applied, and the z test was used for inferential analysis. SPSS software (version 27) was used for data analysis, and the significance level was 5%. RESULTS: Of the 54 interviewees, the majority were women, married, retired, and had a good quality of life. Of these, 48.1% (n=26) were infected by COVID-19, 61.5% (n=16) of whom progressed to long COVID, presenting with fatigue or muscle weakness. As for the quality of life, the "social overload" (P<.001) and "sexual functioning" (P<.001) dimensions had with low scores compared to the "energy and mobility" (P=.005), "diabetes control" (P<.001), and "anxiety and worry" (P<.001) dimensions. Quality of life was negatively impacted in the "anxiety and worry" dimension. Among those affected by COVID-19, most progressed to long COVID; however, there was a lack of data on this theme in the population of older people with diabetes. CONCLUSIONS: The majority of interviewees progressed to long COVID, with their quality of life negatively impacted in the "anxiety and worry" dimension, reflecting that health actions prioritizing mental health should be implemented by health professionals.

Sociodemographic Profile, Health Conditions, and Burden of Informal Caregivers of Older Adults in Brazil During the COVID-19 Pandemic: Cross-Sectional, Exploratory, Noninterventional, Descriptive Study.

BACKGROUND: Demographic changes in the world population have resulted in an increasingly aging society, with a progressive increase in the number of people in situations of dependence, who require assistance from family members to meet their basic needs. Caring for older adults involves performing diverse activities, resulting in reduced free time and tiredness, and fulfilling the demands and expectations related to personal, family, physical, and social life, consequently compromising the quality of life of the caregiver. In this context, the informal caregiver of hospitalized older adults emerges as the focus of attention. OBJECTIVE: The aim of this study was to describe the sociodemographic profile, health conditions, and burden of informal caregivers of older adults admitted to a university hospital in Brazil during the COVID-19 pandemic period. METHODS: This is a cross-sectional, descriptive, and analytical study that was conducted with 25 informal caregivers of hospitalized older adults in a university hospital in Brazil between August and September 2022. Three instruments were applied: Caregiver Burden Inventory, sociodemographic questionnaire, and health conditions questionnaire. The data were analyzed using SPSS version 28.0. Descriptive (frequency and percentage) and inferential analyses were performed using 2-sided Student t test with 95% CIs. RESULTS: Of the 25 interviewees, 18 (72%) were females, 17 (46%) were married or in a stable union, 14 (56%) completed secondary education, and 11 (44%) lived with the older adults who needed care. The average age of the participants was 44 (SD 12.8) years. Regarding their health conditions, most caregivers self-reported it as good (12/25, 48%). They provided care to their father or mother older than 70 years (14/25, 56%). The Caregiver Burden Inventory analysis showed that the caregivers were the most negatively impacted in the domains of personal life overload (mean 10.8, SD 3.46; P=.047) and physical overload (mean 10.6, SD 2.32; P=.02). CONCLUSIONS: In recent years, there has been an increase in the burden on informal caregivers of hospitalized older adults in Brazil, thereby impacting their personal and physical lives. The findings of our study show that health care professionals should be trained to promote health guidelines and actions to improve the personal and physical lives of the caregiver population in Brazil.